Eligibility Manager, Partner Relations

As an Eligibility Manager, Partner Relations, you will lead a team responsible for the delivery and integrity of outbound eligibility operations, including file transmission, partner integrations, and compliance-driven workstreams such as Medicare and COB. This role is critical in ensuring accurate, timely data exchange with external partners while maintaining strict adherence to regulatory and operational standards.

You will serve as the primary point of accountability for partner relationships, driving strong communication, collaboration, and trust. In addition to overseeing day-to-day operations, you will manage complex partner implementations and renewals, ensuring consistency, accuracy, and scalability across all outbound processes.

Reporting into Eligibility leadership, this role plays a key part in strengthening partner confidence, improving file management quality, and advancing Collective Health’s ability to deliver reliable, compliant eligibility solutions at scale.
This role sits at the intersection of operational execution, partner experience, and compliance. Success requires delivering accurate, timely outbound data while navigating complex partner requirements and regulatory demands—ensuring both operational integrity and long-term partner trust.

What you'll do:

• Identify and implement operational goals and performance targets aligned to organizational objectives
• Lead teams to ensure goals are clearly understood, measured, and consistently achieved
• Drive adherence to defined processes, ensuring accuracy, compliance, and efficiency in outbound eligibility operations
• Provide continuous coaching, feedback, and development through one-on-ones and performance management
• Foster a high-performing, collaborative, and inclusive team culture
• Lead hiring, performance reviews, promotions, and career development planning
• Serve as the primary point of contact for external partners, fostering strong communication, collaboration, and long-term relationships
• Build trust and confidence through consistent, transparent engagement and reliable execution
• Co-design solutions with internal stakeholders and partners where applicable to improve data exchange, workflows, and outcomes
• Act as a partner advocate internally, ensuring needs, constraints, and expectations are clearly represented
• Proactively solicit and incorporate partner feedback to strengthen processes and relationships
• Maintain accountability for the timely and accurate delivery of outbound eligibility files across all partners
• Ensure data integrity, proper formatting, and successful transmission of eligibility files (e.g., 834 and other outbound formats)
• Identify, address, and minimize errors in outbound processes to reduce discrepancies and rework
• Oversee discrepancy resolution workflows, ensuring alignment with SLAs and partner expectations
• Continuously evaluate and improve outbound processes to increase reliability and efficiency
• Oversee partner eligibility implementations and renewals, ensuring seamless setup and consistent execution of eligibility requirements
• Demonstrate deep knowledge of partner-specific requirements, file logic, and operational dependencies
• Lead complex, compliance-driven workstreams including Medicare, COB, and other regulatory processes, ensuring accuracy and adherence to requirements
• Partner with internal teams to manage timelines, dependencies, and risk mitigation for partner launches and changes
• Ensure all outbound processes meet regulatory, audit, and compliance standards, minimizing risk to the business
• Translate organizational goals into actionable outbound processes and guide execution across the team
• Drive continuous improvement using data to identify inefficiencies, reduce errors, and enhance delivery performance
• Lead change management efforts related to partner processes, system updates, and compliance requirements
• Align outbound operations with broader organizational strategy and industry best practices
• Partner closely with Product, Engineering, Client Success, and Operations teams to ensure alignment and execution
• Collaborate on system enhancements, file capabilities, and reporting improvements to support partner needs
• Communicate effectively across stakeholders to resolve issues, drive decisions, and ensure successful outcomes

To be successful in this role, you'll need:

• 5+ years of management experience, including team leadership, strategic planning, and operational execution
• Deep understanding of outbound data processes, file structures, and system integrations
• Demonstrated ability to develop and mentor team members
• Experience managing compliance-heavy programs (e.g., Medicare, COB, regulatory reporting)
• Extensive experience in eligibility processing, healthcare systems, EDI, and outbound file management
• Experience working within compliance and regulatory frameworks, particularly related to healthcare data such as CMS and state specific rules
• Experience working with healthcare partners, carriers, or third-party administrators
• Familiarity with tools such as Google Workspace, JIRA, Zendesk, and Smartsheet

Pay Transparency Statement 

This is a hybrid position based out of our Lehi office, with the expectation of being in office at least two weekdays per week. #LI-hybrid

The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the salary, you will be eligible for 70,000 stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/benefits/.